Antibiotic appropriateness and guideline adherence in hospitalized children: results of a nationwide study

McMullan, Brendan; Hall, Lisa; James, Rodney; Mostaghim, Mona; Jones, Cheryl; Konecny, Pamela; Blyth, Christopher C; Thursky, Karin

doi:10.1093/jac/dkz474

Cited by 17 publications

(19 citation statements)

References 18 publications

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“…These data support identifying targets for action, and they are a core contributor to both patient safety 11 and AMR initiatives. 9,15,16 In this study, we provided a detailed Australia-wide snapshot of hematology and oncology patients, which allows in-depth evaluation of antimicrobial prescribing and utilization among these vulnerable patient groups. We identified a number of areas unique to hemBMT and to oncology suitable for stewardship intervention.…”

Section: Discussionmentioning

confidence: 99%

Quality of inpatient antimicrobial use in hematology and oncology patients

Douglas

Hall

James

et al. 2021

Infect. Control Hosp. Epidemiol.

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Objectives: To compare antimicrobial prescribing practices in Australian hematology and oncology patients to noncancer acute inpatients and to identify targets for stewardship interventions. Design: Retrospective comparative analysis of a national prospectively collected database. Methods: Using data from the 2014–2018 annual Australian point-prevalence surveys of antimicrobial prescribing in hospitalized patients (ie, Hospital National Antimicrobial Prescribing Survey called Hospital NAPS), the most frequently used antimicrobials, their appropriateness, and guideline concordance were compared among hematology/bone marrow transplant (hemBMT), oncology, and noncancer inpatients in the setting of treatment of neutropenic fever and antibacterial and antifungal prophylaxis. Results: In 454 facilities, 94,226 antibiotic prescriptions for 62,607 adult inpatients (2,230 hemBMT, 1,824 oncology, and 58,553 noncancer) were analyzed. Appropriateness was high for neutropenic fever management across groups (83.4%–90.4%); however, hemBMT patients had high rates of carbapenem use (111 of 746 prescriptions, 14.9%), and 20.2% of these prescriptions were deemed inappropriate. Logistic regression demonstrated that hemBMT patients were more likely to receive appropriate antifungal prophylaxis compared to oncology and noncancer patients (adjusted OR, 5.3; P < .001 for hemBMT compared to noncancer patients). Oncology had a low rate of antifungal prophylaxis guideline compliance (67.2%), and incorrect dosage and frequency were key factors. Compared to oncology patients, hemBMT patients were more likely to receive appropriate nonsurgical antibacterial prophylaxis (aOR, 8.4; 95% CI, 5.3–13.3; P < .001). HemBMT patients were also more likely to receive appropriate nonsurgical antibacterial prophylaxis compared to noncancer patients (OR, 3.1; 95% CI, 1.9–5.0; P < .001). However, in the Australian context, the hemBMT group had higher than expected use of fluoroquinolone prophylaxis (66 of 831 prescriptions, 8%). Conclusions: This study demonstrates why separate analysis of hemBMT and oncology populations is necessary to identify specific opportunities for quality improvement in each patient group.

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Section: Discussionmentioning

confidence: 99%

Quality of inpatient antimicrobial use in hematology and oncology patients

Douglas

Hall

James

et al. 2021

Infect. Control Hosp. Epidemiol.

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“…In general, a very variable level of adherence to existing guidelines has already been observed by the treating physicians for a wide range of pediatric diseases. For example, guideline adherence regarding the use of antibiotics in infectious disease is a highly investigated subject [ 19 , 20 , 21 ]. These studies showed no change of management in urinary tract infections after introduction of the guideline, whereas the use of antibiotics in community-acquired pneumonia was evidence-based.…”

Section: Discussionmentioning

confidence: 99%

Guideline Adherence and Registry Recruitment of Congenital Primary Hypothyroidism: Data from the German Registry for Congenital Hypothyroidism (HypoDok)

Thomann

Voß

Oeverink

et al. 2021

IJNS

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Neonatal screening for congenital primary hypothyroidism (CH) is mandatory in Germany but medical care thereafter remains inconsistent. Therefore, the registry HypoDok of the German Society of Pediatric Endocrinology and Diabetology (DGKED) was analyzed to evaluate the implementation of evidence-based guidelines and to assess the number of included patients. Inclusion criteria were (i) date of birth between 10/2001 and 05/2020 and (ii) increased thyroid-stimulating hormone (TSH) at screening and/or confirmation. The cohort was divided into before (A) and after (B) guideline publication in 02/2011, to assess the guideline’s influence on medical care. A total of 659 patients were analyzed as group A (n = 327) and group B (n = 332) representing 17.5% and 10.3% of CH patients identified in the German and Austrian neonatal screening program during the respective time period. Treatment start and thyroxine doses were similar in both groups and consistent with recommendations. Regular follow-ups were documented. In the first three years of life, less than half of the patients underwent audiometry; developmental assessment was performed in 49.3% (A) and 24.8% (B) (p < 0.01). Documentation of CH patient care by pediatric endocrinologists seemed to be established, however, it reflected only a minority of the affected patients. Therefore, comprehensive documentation as an important instrument of quality assurance and evidence-based medicine should be legally enforced and officially funded in order to record, comprehend, and optimize care and outcome in patients with rare diseases such as CH.

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“…In general, a very variable level of adherence to existing guidelines has already been observed by the treating physicians for a wide range of paediatric diseases. Guideline adherence regarding the use of antibiotics in infectious disease is a highly investigated subject [15][16][17]. The studies showed no change of management in urinary tract infections after introduction of the guideline, whereas the use of antibiotics in CAP was evidence-based.…”

Section: Discussionmentioning

confidence: 99%

Guideline Adherence and Registry Recruitment of Congenital Primary Hypothyroidism: Data From the German Registry for Congenital Hypothyroidism (HypoDok)

Thomann

Voß

Oeverink

et al. 2020

Preprint

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Background: Neonatal screening for congenital primary hypothyroidism (CH) is mandatory in Germany but medical care thereafter remains inconsistent. Therefore, the multicentre database HypoDok was analysed to evaluate the implementation of evidence-based guidelines in the care of children with CH and to assess the number of patients in this registry of the German society of paediatric endocrinology and diabetology (DGKED).Methods: HypoDok includes the prospective documentation of 1,630 patients with CH from 50 centres in Germany and Austria. Inclusion criteria were (i) date of birth between 10/2001 and 05/2020 and (ii) increased TSH at screening and/or confirmation. Parameters regarding diagnosis, therapy and follow-up were extracted. The number of registered patients was compared to the number in the report of the German Society for Neonatal Screening (DGNS). The cohort was divided into 2 groups, before (A) and after (B) guideline publication in 02/2011, to assess guideline’s influence on medical care.Results: 659 patients (62% female) were eligible and analysed as group A (n=327) and group B (n=332) representing 17.5% and 6.7% of CH patients identified in the German and Austrian neonatal screening program during the respective time period. Treatment start and thyroxin doses were similar in both groups and consistent with recommendations. Regular follow-ups were documented in both groups including five appointments in the first and three in the second year of life. Ultrasound of the thyroid gland was performed in 92.6% (A) and 92.1% (B) of the patients. In the first three years of life, 46.4% (A) and 40.0% (B) of the patients underwent audiometry, EQ/IQ testing was performed in 49.3% (A) and 24.8% (B) (p<0.01), respectively.Summary: While documentation of care for patients with CH by paediatric endocrinologists seems to be established, only a minority of all affected patients is included in HypoDok. Thus, the care and outcome of the majority of patients with CH remains uncertain. Therefore, comprehensive documentation as an important instrument of quality assurance and evidence-based medicine should be legally enforced and officially funded in order to record, comprehend and optimize care and outcome in patients with rare diseases such as CH, irrespective of treatment provider.

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Antibiotic appropriateness and guideline adherence in hospitalized children: results of a nationwide study

Cited by 17 publications

References 18 publications

Quality of inpatient antimicrobial use in hematology and oncology patients

Quality of inpatient antimicrobial use in hematology and oncology patients

Guideline Adherence and Registry Recruitment of Congenital Primary Hypothyroidism: Data from the German Registry for Congenital Hypothyroidism (HypoDok)

Guideline Adherence and Registry Recruitment of Congenital Primary Hypothyroidism: Data From the German Registry for Congenital Hypothyroidism (HypoDok)

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